Ramadan Health Guide

a guide to healthy fasting Supported by the
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11685 Ramadan Report 4th.indd 1 7/9/07 21:00:32
Contents
Page 28 Tips for healthcare professionals
Page 3 Foreword
Page 4 Acknowledgements and useful contacts
Page 5 Introduction
Page 6 The physiological changes that
occur during a fast
Page 8 Foods that benet and
foods that harm
Page 20 Frequently asked questions
Page 12 Spirituality and food
Page 14 What could you gain from fasting?
Page 16 Potential health complications and
possible remedies
Page 24 Key points in translation
FASTING is complete abstinence from food and drink between dawn and dusk.
All those who are ill or frail, pregnant or menstruating women, breastfeeding
mothers and travellers are exempted. They are required to make up the
number of days missed at a later date or give a xed sum to charity.
2
I am very pleased to support the development of the Ramadan health guide, which has
been independently produced by Communities in Action in order to provide information
and advice on maximising health gain during the Muslim fast. We hope it will also prove
useful to others fasting for religious or spiritual reasons.
The Department of Health is committed to responding to the needs and preferences of
all sections of our diverse population, and this guide is one of a range of activities we
have supported in order to promote public health among all sections of the population.
There is considerable evidence to suggest that large sections within Muslim
communities experience signicant health inequalities, although this is not uniform
across all Muslim communities or all aspects of health. In particular, Pakistani and
Bangladeshi communities tend to suffer poorer health than the general population.
We hope that this guide, alongside the Departments targeted campaigns, such as our
Asian Tobacco Helpline, will help to address these inequalities.
As part of our commitment to creating a patient-led NHS, the Department of Health and
the NHS will continue to work in partnership with community-based organisations to
meet the needs of all communities, including faith communities, and to promote better
health for all.
Surinder Sharma
National Director, Equality and Human Rights
Department of Health
Foreword
3
Communities in Action would like to thank the following individuals for their
contribution to this publication:
Edited and compiled by:
Ajmal Masroor, Director, Communities in Action
Authors: Dr Razeen Mahroof, BM, MRCP(UK), FRCA, Anaesthetist, Oxford
Dr Rizwan Syed, BM, DRCLG, General Practitioner, Birmingham
Dr Ahmed El-Sharkawy, BM, MRCP(UK), Specialist Registrar in
Gastroenterology
Tehseen Hasan, BSc(Hons), State Registered Dietitian, Birmingham
Sahra Ahmed, MPharm, Pharmacist, Manchester
Dr Fuad Hussain
Revised: Dr Naveed Ahmed
Dr Amar Ahmed
Research: Henrietta Szovati, Communities in Action
Dr Shahnaz Ahmad, DRCOG, MRCGP
Dr Amar Ahmed, MBBS, DCH, DRCOG, MRCGP
Dr N Ahmad, MRCS, MSc, BSc(Hons), DO-HNS, Specialist
Registrar in ENT Surgery
Advisors: Dr Fatima Husain, MBBS, MRCGP, MRCOG, DIPM, Consultant
Obstetrician and Gynaecologist
Dr Usama Hasan,
Imam and Lecturer
Layout and design:
Nafe Anam
Acknowledgements
British Heart Foundation
14 Fitzhardinge Street
London W1H 6DH
020 7935 0185
www.bhf.org.uk
Diabetes UK Central Ofce
Macleod House
10 Parkway
London NW1 7AA
tel: 020 7424 1000
fax: 020 7424 1001
email: info@diabetes.org.uk
www.diabetes.org.uk
NHS Asian Tobacco Helpline
For free and condential advice on how to stop
smoking or chewing tobacco:
Bengali 0800 00 22 44
Urdu 0800 00 22 88
Punjabi 0800 00 22 77
Turkish 0800 00 22 99
Gujarati 0800 00 22 55
Arabic 0800 169 1300
NHS Smoking Helpline
0800 169 0169
www.gosmokefree.co.uk
The Muslim Council of Britain
PO Box 57330
London E1 2WJ
tel: 0845 26 26 786
fax: 020 7247 7079
email: admin@mcb.org.uk
www.mcb.org.uk
Useful contacts
4
Introduction
Health is the key to happiness, and what we consume
directly affects our health. Islam encourages Muslims to
ensure that they are mindful of their health. The blessed
Prophet said: Take advantage of the good health before
illnesses afict you. He also encouraged Muslims to try
their best to take up a healthy living lifestyle that includes
a balanced diet, regular mental and physical exercise and
a balance between material and spiritual needs.
The Health Survey for England 2004 (Department of
Health, 2005) has shown poor health and lifestyle choices
of the Asian community in general and Muslim community
in particular. Compared with the 24% of men in the
general population who smoked cigarettes, higher levels
of cigarette smoking were reported by Bangladeshi men
(40%). South Asian men and women had the highest
rates of diabetes. Pakistanis and Bangladeshis were up
to ve times more likely than the general population to
have diabetes, and Indian men and women were up to
three times as likely. Some 33% of Pakistani men and
women eat the recommended ve or more portions of
fruit and vegetables a day,
compared with 28% of
Bangladeshi men
and women.
The month of Ramadan is a great opportunity to focus on
bringing back a balanced and healthy lifestyle in your life.
Through fasting you begin to learn how to manage your
eating habits, how to improve self-control and discipline.
This month requires you to give the stomach a break, and
by doing so you are able to break down and expel the
accumulated toxins from your body.
This booklet is aimed at helping you understand the
health issues related to fasting, so that you are able to
make more informed choices, minimise complications
and maximise the benet of your fast. The booklet will:
guide you through physiological changes that occur
when you are fasting; give examples of benecial and
harmful foods during fasting; discuss potential medical
problems and remedies; suggest a diet plan; and respond
to the most frequently asked questions about fasting in
general and medical issues in particular. The booklet also
contains a section for doctors and medical professionals,
to enable them to provide more informed services.
The booklet has been put together by medical experts,
Islamic scholars and researchers, who have stayed within
the spirit of Islam, while ensuring the medical advice and
suggestions are scientic and culturally sensitive.
5
For many people, the key question regarding fasting is
whether it is good or bad for your health. The answer to
this requires a quick overview of what happens inside the
body during fasting: the physiology of fasting.
The changes that occur in the body in response to fasting
depend on the length of the continuous fast. Technically
the body enters into a fasting state eight hours or so after
the last meal, when the gut nishes absorption of nutrients
from the food. In the normal state, body glucose, which is
stored in the liver and muscles, is the bodys main source
of energy. During a fast, this store of glucose is used up
rst to provide energy. Later in the fast, once the stores
of glucose run out, fat becomes the next store source of
energy for the body. Small quantities of glucose are also
manufactured through other mechanisms in the liver.
Only with a prolonged fast of many days to weeks does
the body eventually turn to protein for energy. This is
the technical description of what is commonly known as
starvation, and it is clearly unhealthy. It involves protein
being released from the breakdown of muscle, which
is why people who starve look emaciated and become
very weak.
As the Ramadan fast only extends from dawn till dusk,
there is ample opportunity to replenish energy stores at
pre-dawn and dusk meals. This provides a progressive,
gentle transition from using glucose to fat as the main
source of energy, and prevents the breakdown of muscle
for protein. The use of fat for energy aids weight loss,
preserving the muscles, and in the long run reduces
your cholesterol levels. In addition, weight loss results in
better control of diabetes and reduces blood pressure.
A detoxication process also seems to occur, as any
toxins stored in the bodys fat are dissolved and removed
from the body. After a few days of the fast, higher levels
of certain hormones appear in the blood (endorphins),
resulting in a better level of alertness and an overall
feeling of general mental well-being.
Balanced food and uid intake is important between
fasts. The kidney is very efcient at maintaining the
bodys water and salts, such as sodium and potassium.
However, these can be lost through sweating. To prevent
muscle breakdown, meals must contain adequate levels
of energy food, such as carbohydrates and some fat.
Hence, a balanced diet with adequate quantities of
nutrients, salts and water is vital.
The physiological changes that
occur during a fast
6
Normally produces insulin.
During fasting, insulin production is
shut down and hormones that tell the
liver and muscles to release sugar
stores are produced. Also, production
of digestive juices is reduced
Acid production
by the stomach
is reduced during
fasting
No changes
known to occur
during fasting
This is where a lot of the
water absorption occurs
from the food, and second
to the kidney it is important
in water balance in the body
Digestive juices production
is shut down and there are
regular contractions of the
whole small intestine once
every 4 hours
Concentrates bile
during the fast in
readiness for the
next meal
The bodys main controller
of energy reserves. During
fasting, the liver releases
sugar by breaking down
stores in the organ
No changes
known to occur
during fasting
7
The fasts of Ramadan can improve a persons health, but
if the correct diet is not followed can possibly worsen
it! The deciding factor is not the fast itself, but rather what
is consumed in the non-fasting hours. To fully benet from
fasting, a person should spare a great deal of thought to
the type and quantity of food they will indulge in through the
blessed month. As mentioned in the section on spirituality
(see pages 1213), overeating can not only harm the body
but it is thought also to interfere with a persons spiritual
growth during the month. A diet that has less than a normal
amount of food but is sufciently balanced will keep a
person healthy and active during the month of Ramadan.
The diet should be simple and not differ too much from
ones normal everyday diet. It should contain foods from all
the major food groups, as shown below.
Foods that benet and
foods that harm
Fruit and vegetables Bread, other cereals
and potatoes
Milk and
dairy foods
Meat, sh and
alternatives
Foods containing fat
Foods containing sugar
8
9
Complex carbohydrates are foods that will help release
energy slowly during the long hours of fasting. Complex
carbohydrates are found in grains and seeds, like barley,
wheat, oats, millets, semolina, beans, lentils, wholemeal
our, basmati rice, etc.
Fibre-rich foods are also digested slowly and include
bran, cereals, whole wheat, grains and seeds, potatoes
with the skin, vegetables such as green beans and
almost all fruit, including apricots, prunes, gs, etc.
9
Foods to avoid are the
heavily-processed,
fast-burning foods
that contain rened
carbohydrates in the form
of sugar, white our, etc.,
as well as, of course, too
much fatty food (eg cakes,
biscuits, chocolates and
sweets, such as Indian
Mithai). It may also be
worth avoiding the caffeine
content in drinks such
as tea, coffee and cola.
(Caffeine is a diuretic and
stimulates faster water loss
through urination.)
Foods to avoid Healthy/alternative foods
Deep-fried foods, eg pakoras,
samosas, fried dumplings
Whole grains, eg chickpeas (plain,
or with potato in yogurt with different
Indian spices), samosas baked instead
of fried, and boiled dumplings
High-sugar/high-fat foods, eg Indian
sweets such as Ghulab Jamun,
Rasgulla, Balushahi, Baklawa
Milk-based sweets and puddings,
eg Rasmalai, Barfee
High-fat cooked foods, eg parathas,
oily curries, greasy pastries
Alternate with chapattis made without
oil, and baked or grilled meat and
chicken. Try to make pastry at home
and use a single layer
Cooking methods to avoid Alternative cooking methods
Deep frying Shallow frying usually there is very
little difference in taste
Frying Grilling or baking is healthier and helps
retain the taste and original avour of
the food, especially chicken and sh
Curries with excessive oil Start with measuring the oil used in
curry and try to bring the oil content
down gradually, eg reducing ve
tablespoons to four. This is a good
way of reducing oil without noticing
much difference in the taste. A useful
tip is to use more onions and tomatoes
in the bulk of the curry
8
8 8
8
8
9
10
8
9
Suhoor, the pre-dawn meal, should be a wholesome,
moderate meal that is lling and provides enough energy
for many hours. It is therefore particularly important to
include slowly-digesting foods in the suhoor.
Iftar is the meal which breaks the days fast. This meal
could include dates, following the Prophetic traditions.
Dates will provide a refreshing burst of much-needed
energy. Fruit juices will also have a similar, revitalising
effect. The meal should remain a meal and not become
a feast! Try to minimise the rich, special dishes that
traditionally celebrate the fast and keep to the advice
included in the table opposite.
Many of the foods which are mentioned and encouraged
in this booklet are in the Holy Quran, and the Sunnah
(the Prophetic traditions) also correspond to modern
guidelines on a healthy diet and will help to maintain
balanced, healthy meals in Ramadan. The most
commonly consumed foods by Prophet Mohammed
(peace be upon him) were milk, dates, lamb/mutton and
oats. Healthy foods mentioned in the Holy Quran are
fruit and vegetables, such as olives, onions, cucumber,
gs, dates, grapes as well as pulses such as lentils. The
encouragement of sh can be seen in the fact that Islamic
law spares sh from any specic slaughter requirements,
making it easy to incorporate sh in a meal.
11
Food has a great signicance in Islam. It is associated
with ones relationship with God. Chapter 20, verse 81 of
the Quran states: Eat of the good and wholesome things
that We have provided for your sustenance, but indulge in
no excess therein.
The physical body is a gift from God; it is given to humans
as an amanah (in trust) to take care of for a xed period.
How much food is consumed and the choice of food has a
direct impact on the physical and spiritual well-being of the
person. The food that you consume affects your behaviour
and personality. Wholesome, natural and healthy food
assists the development of a good personality. Overeating
has long been frowned upon in Islam as it is thought
to increase worldly appetites and cause sluggishness,
thereby dulling the soul, hampering spiritual growth and
increasing physical ailments.
The blessed Prophet said: The children of Adam ll no
vessel worse than their stomach. Sufcient for him is a
few morsels to keep his back straight. If he must eat more,
then a third should be for his food, a third for his drink, and
a third left for air. (Sunan al-Tirmidh)
Islam sees health and well-being as much more than just
bodily health: well-being or tranquillity requires a strong
relationship with ones spirituality, good physical health,
mental happiness, a sense of purpose and good character
and relationships. Islam makes a strong connection
between food and worship and teaches that all forms of
worship have a deeper purpose and impact and contribute
in some way to individual and social well-being.
In chapter 7, verse 31 the Quran is categorical: Eat and
drink freely: but waste not by excess, for He does not like
the wasters.
Spirituality and food
12
Islam thus creates a sense of responsibility in people to take
a healthy living lifestyle as normal. Fasting in the month of
Ramadan teaches us to manage and practise spirituality and
not to eat excessively. The essential part of spirituality in
food is that we are grateful and thankful for the food we get.
The blessed Prophet once said: God has a right over
you; your body has a right over you To strike a balance
between the needs of the physical body and your spiritual
needs, you must on the one hand consume the right type
and amount of food and on the other hand develop excellent
interpersonal skills. The blessed Prophet Muhammad said:
I have only been sent for the perfection of character.
Fasting in the month of Ramadan is an opportunity to make
signicant changes in your lifestyle and develop the resolve
to make healthy living choices.
13
Fasting is not only a physical but also a
spiritual exercise that has many lasting
benets.
1. Heightened consciousness of God
Fasting helps you to become less
preoccupied with bodily appetites, and
gives the heart and mind the freedom to
reect upon deeper spiritual matters, such
as your relationship with God and with
fellow human beings. It enables a person
to develop sustained consciousness of
God (Taqwa).
2. Healthy lifestyle
A fasting person learns restraint, and
only responds to hunger and thirst in the
heightened level of consciousness and
discipline. Through fasting, a person
begins to appreciate the value of food. In
the Quran healthy and wholesome food
is described as the best of provisions.
Thus fasting helps a person to choose
a healthier lifestyle by making small yet
lasting changes to their daily diet.
What could you gain
from fasting?
14
3. Compassion and charity
When fasting, you should think of those in need who may
be fasting but have no food at the start or the end of their
fast, those whose tiny children are also having to go hungry
because of poverty. The Prophet Muhammad described
Ramadan as the month of mercy. His companions
observed: The Prophet (Muhammad) was the most
generous of people, but he would be his most generous
during Ramadan (Sahih al-Bukhari)
4. Community spirit
During Ramadan, the one who fasts has heightened
concerns for the well-being of the community rich and
poor, intellectuals and labourers. Community spirit is
promoted as people start fasting at the same time and break
their fast at the same time, and reect together through
longer prayer and deeper devotions. It is greatly encouraged
that families invite each other to break their fast together.
5. A fast without the spirit is empty of blessing
Abstention for long hours can be very hard physically and
spiritually. However, by the end of the long month you
should feel cleansed and with a renewed spirit. Ramadan
is an ideal time to break bad habits, to reect on personality
and to improve your character.
Those who fast but make no change to their lives except
delaying a meal cannot really expect to become any
different in their behaviour during or after Ramadan. In
many ways, this is a wasted fast, as stressed in a number
of sayings of the blessed Prophet: fasting is not merely
abstention from eating and drinking, but also from vain
speech and foul language. (Sahih al-Bukhari)
Fasting is, therefore, about much more than just giving
up food and drink and hoping to lose a couple of pounds.
By fasting, a person reects, acts and betters his or her
character.
15
Heartburn (indigestion)
The stomach is an acidic environment, designed to digest food and
kill bacteria. The stomach and oesophagus (gullet) are normally
protected from this acid by the bodys own special juices and valves
between these two organs. If either too much acid is produced or the
valve at the bottom of the oesophagus is faulty, you may experience
heartburn. Fasting usually reduces the amount of acid produced, but
thoughts of food or the smell of it make the brain order the stomach to
produce more acid. Hence if there is a net increase in acid, heartburn
could be a problem during the fast.
Those who are on regular medication for indigestion, such as antacids
(eg Gaviscon), antihistamines (eg Zantac) or proton pump inhibitors
(eg Losec, Zoton or Nexium) are advised to continue taking them, at
the pre-dawn meal for instance. The control of heartburn or belching
can be aided by eating in moderation and avoiding oily, deep-fried
or very spicy food. Reducing your caffeine intake and/or stopping
smoking can also be of benet, if relevant. Preparations such as
peppermint oil may help reduce belching or colic. Sleeping with your
head raised on a few pillows and long-term weight loss may also help
prevent heartburn.
Potential health complications
and possible remedies
16
Poor control of diabetes
Those injecting insulin are advised not to fast, as the potential
risk to health, both in the short and long term, of not taking
insulin is too great.
People who have their diabetes under control using tablets
should ensure that they visit their GP prior to Ramadan, in
order to discuss any possible changes to their drug regime
which would facilitate a safe fast. If not, such patients are
at risk of poor control of their diabetes during and outside the
fasting times.
Regular self-monitoring of your blood glucose is strongly
advised. Low blood sugar levels (a hypo) are dangerous,
and if untreated may lead to fainting or ts, and hence must be
strictly avoided. Feeling dizzy, sweaty and disorientated may
all suggest a hypo. If this is suspected, you should immediately
have a sugary drink, or place sugar or a sugar-rich sweet below
the tongue.
Long-acting tablets, such as Glibenclamide, increase the risk
of having a hypo, and should be changed to a shorter-acting
variety before you embark on a fast.
Diabetics with further complications, such as angina or heart
failure, stroke, retinopathy (eye disease), nephropathy (kidney
disease) or neuropathy (nerve disease of feet/hands with
numbness/loss of feeling) should seek careful advice from their
doctor before starting a fast.
17
Headache
This is a common problem and has many causes.
Headaches during a fast could commonly be due to
dehydration or hunger, inadequate rest, or the absence of
addictive substances such as caffeine or nicotine.
A moderate and balanced diet, especially not missing
the pre-dawn meal, consuming adequate quantities of
uid and if necessary taking a dose of painkillers such
as paracetamol, may all go a long way towards either
preventing or reducing the risk of developing a disabling
headache. Headaches can also be prevented by sensible
measures such as not exposing oneself to direct sunlight,
wearing a hat when out, using sunglasses to reduce the
effect of glare from the
sun and relieving any
tense muscles with a
short, gentle massage.
Those with a history of frequent and/or disabling
migraines should aim to gain adequate control with
lifestyle and/or medical treatment if required, prior to
starting a fast.
Despite the above measures, if you have a persistent,
disabling headache, you should see a doctor.
Dehydration
Dehydration is a common occurrence during a fast. The
body continues to lose water and salts through breathing,
sweat and urine; the quantity of water loss will vary
depending on the weather, how much you had to drink
before your fast, the degree of physical exertion and the
ability of the kidneys to retain water and salts.
Prevention is always better than cure. However, if you
do not adequately rehydrate before a fast, your risk of
dehydration is increased. This risk is higher in the elderly
and in those taking tablets such as diuretics. Depending
on the severity of the dehydration, you may experience a
general feeling of being unwell, lethargy, muscle cramps,
dizziness, disorientation and even collapse or fainting.
If you are unable to stand up due to dizziness, or you are
disorientated, you should urgently rehydrate with regular,
moderate quantities of water, ideally with sugar and salt,
or Dioralyte or Lucozade.
18
If you faint due to dehydration, your legs should be raised
above your head by others, and when you awake, you
should urgently rehydrate as outlined above.
Complications of any common chronic diseases
Diabetes has been discussed above.
Other common diseases such as high blood pressure and
asthma are controlled using medication that needs to be
taken regularly every day of the year. This is necessary
in order to avoid possible complications from the
inadequate control of disease, such as a stroke or an
asthma attack. A consultation with your doctor should
provide an opportunity to discuss any potential options
for completing a fast safely, while continuing to control
your disease.
Constipation
Constipation could be a very irritating problem for
someone undertaking a fast. Maintaining good hydration
outside the fast, eating healthily, with lots of fruit and
vegetables in your diet, increasing the bre content of
your food using bran, and being active all help to keep
your bowel motions as regular as would otherwise
be expected.
If the problem persists, a short course of bulk laxatives
may help.
Stress
Lack of food and water, changes of routine and shorter
periods of sleep can all collude to increase stress levels.
Hence it is important to address any potential sources of
stress in order to minimise harmful effects. This can be
helped by not taking on more than you can reasonably
handle, not playing sports in the hot sun, controlling your
anger in advance and abstaining from smoking.
Obesity
Strange, but true! For the unwary, or those lacking in
caution, food consumed during the pre-dawn and dusk
meals may lead to some unintended weight gain.
Obesity is an epidemic in the making, and has numerous
complications in its own right. It is ironic that you are able
to become overweight or obese while you are fasting. But
if you do not approach the fast with discipline and will,
the opportunity to lose weight and become healthier
is wasted.
19
Frequently asked questions
A general point about illness and fasting: chapter 2, verse
184 of the Quran makes it explicitly clear that people
who have an illness or medical condition of any kind that
makes fasting injurious to their health are exempt from
fasting. To compensate for the missed fasts, they must
fast later when they are healthy; if this is not possible due
to long-term illness, they must feed the poor. The latter
form of compensation is known as dyah*.
Q1 Should a person with diabetes fast?
People who have their diabetes under control, either
by diet or using tablets, may fast. However, their GP
may require them to make changes to their medication
in order to help them take tablets outside the times of
fasting. Those who need insulin to control their diabetes
are advised not to fast.
20
Q2 I get severe migraines when I skip meals and
they get worse when I fast. Should I fast at all?
Those with uncontrolled migraines are advised not
to fast. However, adequate control of migraines
is possible for most people with medication and
alterations to lifestyle, and hence such avenues
should be exhausted prior to deciding not to fast.
Please see your GP for further advice on better
control of your migraines.
Q3 Should a person with high or low blood
pressure fast?
Those with well-controlled high blood pressure may
fast with lifestyle alterations and/or medication.
Their GP may require a change to their medication
in order to help them take tablets outside the times
of fasting.
A person with so-called low blood pressure who is
otherwise well and healthy may fast. An adequate
intake of uid and salts in the diet is advised.
Q4 Is fasting harmful when a woman is
expecting a baby? Is it compulsory to fast while
pregnant?
It is not compulsory to fast while pregnant, but the
woman will either need to make up those fasts
later or, if unable to do this, should perform dyah*.
There is some medical evidence to show that
fasting in pregnancy is not advisable. If a pregnant
woman feels strong and healthy enough to fast,
especially during the early part of the pregnancy,
she may do so. If she does not feel well enough to
fast, Islamic law gives her clear permission not to
fast, and to make up the missed fasts later.
Q5 Is Ramadan a good time to quit smoking?
Yes. Smoking is wasteful and seriously injurious to
health. Allah has entrusted us with a healthy body,
and it is a violation to knowingly and willingly harm
it. Ramadan provides a great opportunity to amend
many bad habits, and smoking is very denitely one
of them.
Q6 From what age can children fast safely?
Children are required to fast from the age of
puberty, and this is not harmful. Fasting prior to
this age is tolerated differently depending on the
childrens general health, nutrition and attitude.
Fasting prior to the age of seven or eight years is
not advisable, although it is a good idea to make
young children aware of the practice of fasting in the
community around them, and to give them a taste
of fasting, eg for a few hours at a time. It is narrated
that the companions would distract young children
with toys if they were hungry near the time of iftar,
so that they would become accustomed to joining
21
the rest of the community in eating at sunset,
rather than eating just before sunset, during
Ramadan. (Sahih al-Bukhari)
Q7 Can I use an asthma puffer during
Ramadan?
Muslim jurists differ on this issue. Some leading
jurists argue that using an asthma inhaler is not
classied as eating or drinking, and is therefore
permissible during fasting. Others argue that
because the inhaler provides small amounts of
liquid medicine to the lungs, it breaks the fast.
Perhaps the former view is stronger, since the
inhaler assists with breathing and helps the
person to fast, which means abstaining from
food and drink.
According to the rst view, asthmatics may fast
and use their inhalers whenever required during
fasting.
According to the second view, asthmatics with poor
control of their disease are advised not to fast until
good control is achieved. Others may alter their
inhalers to those of a longer-acting variety so that
fasting may be feasible. Please see your GP for
further advice.
Q8 Can I swim during fasting?
Yes, but do not drink the water. Having a bath or
shower or swimming has no effect on the fast.
Clearly, no water should be swallowed during any
of these activities, for that would break the fast.
Q9 Can a person fast if they are getting a blood
transfusion in hospital?
No. A person receiving a blood transfusion is
advised not to fast on medical grounds. They
may fast on the days when no transfusions
are required.
Q10 I am on regular medication. Can I still fast?
If such medication needs to be taken during
the time of fasting, you should not fast. If this
medication is required as treatment for a short
illness, you can compensate for missed fasts by
fasting on other days when you are well.
If medication is required on a long-term basis as
part of an ongoing illness or condition such as high
blood pressure or diabetes, then you may discuss
with your GP whether to change your medication
to a long- or short-acting variety as appropriate, to
enable you to take it outside the time of the fast.
If your disease is unstable or poorly controlled,
you are advised not to fast.
22
Those who are unable to compensate later for
missed fasts, due to the long-term use of medication,
are advised to do dyah*.
Q11 Does a breastfeeding woman have to fast?
No. Islamic law exempts a breastfeeding
mother from fasting. Missed fasts will need to
be compensated for by fasting or dyah* once
breastfeeding has ceased.
Q12 Can a Muslim patient take tablets, injections,
inhalers or patches while fasting?
Taking tablets invalidates the fast. However,
injections, inhalers, patches, ear and eye drops, etc
that are not comparable to food and drink do not
break the fast, although it is advisable to avoid these
if possible due to the difference of opinion among
Muslim jurists on these issues.
Islamic law exempts the sick from fasting. Please
see the answer to Q10 for further details.
Q13 Could dehydration become so severe that
one has to break the fast?
Yes. Harmful levels of water loss could occur if the
person was poorly hydrated before commencing the
fast, and/or could be made worse by activities during
the day and weather conditions. If one produces very
little or no urine, feels disorientated and confused, or
faints due to dehydration, the fast should be broken
in order to rehydrate oneself.
Islam does not require that you harm yourself in
fullling the fast. If a fast is broken, it will need to be
compensated for by fasting at a later date.
Q14 Can I fast while I have dialysis?
Peritoneal dialysis requires the daily usage of
uid bags in the abdomen, and such patients are
advised not to fast (please refer to dyah* below).
Haemodialysis is performed about three times a
week, and results in signicant shifts of uids and
salts within the body. Such patients are also advised
not to fast (please refer to dyah* below).
*Fidyah: a method of compensation in Islam for
a missed act of worship that must be otherwise
fullled. If you are unable to full a missed fast, for
example due to an ongoing illness, you should feed
a hungry person (two meals per day) if you are able
to. Please consult an Islamic scholar for further
details.
23
Key points in translation
Oru byk bir hazrlk gerektiren ziksel ve
manevi bir deneyimdir. E ger ziksel olarak
kendinizi iyi hissetmiyorsanz ya da sa glk
durumunuzdan emin de gilseniz, oruca ba slamadan
nce doktorunuzla konu smanz tavsiye
ederiz. Sa glk durumunuzu ve varsa tedavinizi
etkileyebilecek muhtemel de gi siklikleri veya
alternatieri doktorunuzla gr sn.
Ne yedi giniz ve ne kadar yedi giniz sa gl gnz
direk olarak etkiler. Yemekten uygun bir sekilde
uzak durmak irade gcnz geli stirmenize
yardm edebilir. Oru, ya sam biimize dair
sa glkl seimler yapmak ve kt al skanlklardan
kurtulmak iin bir frsattr. Oru tutarken ve
orucunuzu aarken gsterece giniz zen ziksel ve
manevi sa gl gnza katkda bulunabilir.
Orula sa gl gnza byk katkda bulunun ve sa glk
sorunlarnz azaltn! Bu kitapk orula ilgili
sorularnza aklk getirmek ve neriler sunmak
iin hazrland. Ltfen bu kitap g dikkatle okuyun
ve daha fazla tbbi tavsiye iin doktorunuzla
irtibat kurun.
Fasting is a physical and spiritual experience requiring a great deal
of preparation. If you are physically unwell or not sure of your state
of health, it is advisable that you speak to your doctor before the
fasting commences. Discuss your medical conditions and explore
possible changes to your medication or any other alternatives that
doctors may suggest to suit your needs.
What and how much you eat affects your health directly, and
refraining from food can help improve self-discipline and restraint
if done appropriately. It is an opportunity to make healthy lifestyle
choices and give up some of those bad habits. Being mindful of
how you fast and how you break your fast can help to improve your
overall health both physical and mental.
Maximise on your gain from fasting and minimise health problems.
This booklet will help to explain the issues and suggest remedies.
Please read it carefully and get in touch with your local GP for
further advice.
24
25
Soontu waa-wax jidhkaaga iyo diiniyanba ubaahan khibrad wanaagsan, kontaraag iyo udiyaargarow si hadaad jidhka
kaxanuunsanaysid ama aanad hubin caamaakaga waxaad talo kaqaadankartaa dhakhtar-kaga inta aanad soomin ka hore si aad
ugala hadashid xaalada caamaadkaaga iyo wixiikale ee aad ku badalikartid dawooyinkaaaga ama dhakhtarka wixiikale ee aad
isticimaashidba talo kusiinkara ku naasibta.
Maxay ama intee-inleeg bay cuntadu gaadh-siinkartaa caamaadkaga toosahaan iyo cuntada waxay kaa cawinkartaa inaad
xaqiijisid shiqisayn edabtaada iyo inaad usamaysid sida saxda-ah markaa waxaad haystaa fursad ah caamaadka inaad
udooratid ama aad iska daysid caadada xun siay soontaada iyo afurkaagu ay-kaaga caawinkaraan. Jidhkaaga iyo Maskaxdaada
caamaadkoodaba.
Waxa ugu wayn ee aad soonta ka-heshid iyo wax ugu yare ee caamaad dari-ah. Qoraal kani wuxuu inoo macnaynayaa
soobixidtaanka iyo talooyinka daawooyinka. Fadlan u akhriso si-hobsiimo-leh lana soo xidhiidh dhakhtarka xaafada si aad u
heshid faahfaahin dheeraad ah.
26
27
Tips for healthcare
professionals
Guidance notes on the Muslim fast during Ramadan
The Muslim fast during the month of Ramadan provides
an opportunity for health professionals to promote
health improvement among Muslims by offering lifestyle
advice on topics such as diet and smoking cessation.
It is important to recognise that the Muslim community,
like any other, is diverse. This results in differences of
perception and practice among Muslim patients. The
start of Ramadan advances 11 days every year as it is
based on a lunar calendar and will sometimes fall in the
summer months, resulting in a more onerous fast than
when it is in the winter months. In 2007 Ramadan starts
in mid-September.
Fasting during Ramadan is intended as a discipline and
requires abstinence from anything taken orally during
the hours of daylight, each consecutive day for a month.
This includes water and smoking. Bleeding will also
preclude the fast for that day. Fasting is a requirement
after puberty for all able-bodied Muslims of sound mind
and good health, but there are concessions for those
who are on a journey or who are ill, as well as for women
during menstruation, pregnancy or breastfeeding. The
concessions range from a complete exemption from
fasting, for example for insulin-dependent diabetics,
to a requirement to make up the fast at a later date in
the case of those who are travelling or who have their
periods. A charitable contribution as compensation can
serve as an alternative to keeping the fast later.
Since the month of Ramadan is an important time across
the community, many patients will endeavour to keep
their fasts during this time. With some conditions, this
can clearly be harmful. The concessions exist specically
to ensure that people do not fast where it would be
detrimental to their health, and this is very reasonable
advice to give to patients.
28
For people with acute illnesses, fasts can be broken
and made up later.
For people with many chronic conditions
(eg ophthalmic, dermatological, neurological), fasting
may have no impact and can continue as normal. If
oral medication is required, fasting can be facilitated
by reducing dosing to once or twice daily. Topical
medication, including patches, is acceptable, but
injections are not as they may draw blood.
Fasting itself may have a physiological impact
on diseases affecting the cardiovascular, renal and
gastrointestinal systems, such as hypertension, renal
impairment and peptic ulcers. Although fasting is possible
in many of these circumstances, it may not be well
tolerated physiologically, particularly in older patients and
these may be the very patients who are most adamant
that they wish to perform their fasts. In some cases where
a chronic illness has taken a long while to stabilise and
maintain, adjusting medication around the hours of fasting
may simply be impractical and potentially harmful.
During pregnancy and breastfeeding, the mother's
nutrition and hydration are paramount and, while fasting
is permissible, it is medically better for the mother to
utilise the concession and compensate for or make up
the missed fasts.
Physical examinations, including rectal and vaginal
examinations, do not invalidate the fast. Clinical
investigations such as blood tests, or those requiring
intravenous access or oral contrast, would preclude
the fast during those particular days. Where these are
elective outpatient investigations, many patients may
prefer to reschedule them outside Ramadan. Urgent
investigations should clearly not be delayed.
Each situation needs to be judged on its own merits, in
the context of the patients observance of Ramadan.
A comprehensive guide is not possible, but the examples
above serve to illustrate that there is Islamic
guidance to ensure that fasting is not
prejudicial to a patients health.
29
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283570 1P 200k Sept 07
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Ramadan Health Guide

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a guide to healthy fasting Supported by the

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